BACKGROUND

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Local authorities operate with finite funding and resources with which to support their local population with social care needs. Strategic decisions are made about the use of those resources – between service areas, client types, preventative support versus maintenance etc. Local decisions can be made using a range of criteria and logics. In healthcare, cost-effectiveness approaches have become well-established, particularly through the work of NICE.

 

The ‘cost-effectiveness’ (CE) approach has arguably not (yet) had the same policy purchase in social care as it has in healthcare due to a lack of support and guidance to decision makers about how to interpret and use cost- effectiveness information, and a paucity of cost-effectiveness evidence in social care. A particular issue is the lack of any consensus on what opportunity cost or cost-effectiveness thresholds should be used in social care.

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AIMS

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• Explore barriers to the use of CE approaches, noting the development of national policy to date , and consider how and who might fund the evaluation and CE studies.

• Investigate how far CE ideas are embedded in social care policy locally.

• Work with stakeholders (commissioners and providers) to assess their priorities for developing the CE agenda, and the evaluation culture.

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METHODS

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1. Theoretical analysis and review

Drawing on cost-benefit analysis, economic theory (welfare economics) and implementation science the project will consider how cost-effectiveness logics can be deployed locally. This framework will be used to consider: how information on the cost-effectiveness of adult social care  (ASC) can be used; the limitations of this approach; and the particular characteristics of social care in this regard (e.g. informal care inputs; equity considerations etc.). This framework will be used to understand the role of using a defined opportunity cost-threshold for ASC. A second element will be to consider the setting of an opportunity cost/CE threshold for ASC, building on existing work and broadening out to include the cost- effectiveness of care home services. 

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2. Assessing views of local authorities about a CE approach

Qualitative data collections will be carried out with key stakeholders to determine the extent of the local implementation of CE approaches, with a focus on the enablers and barriers to implementation, and the view of participants about the potential impact of increased use of CE evidence in local decision making. 

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3. Identification of needs for support

A gap analysis will be carried out to determine what tools and guidance might be of help to decision makers to promote the use and implementation of a CE approach.